中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2014年
1期
3-5
,共3页
汪咏莳%董丽莉%姚豪华%王春生%舒先红
汪詠蒔%董麗莉%姚豪華%王春生%舒先紅
왕영시%동려리%요호화%왕춘생%서선홍
主动脉夹层%马凡综合征%先天二叶式主动脉瓣畸形
主動脈夾層%馬凡綜閤徵%先天二葉式主動脈瓣畸形
주동맥협층%마범종합정%선천이협식주동맥판기형
Acute aortic dissection%Marfan syndrome%Bicuspid aortic valve
目的 探讨马凡综合征与先天二叶式主动脉瓣畸形发生急性Stanford A型主动脉夹层的临床特征和手术早期预后.方法 回顾性分析2008年4月至2012年4月复旦大学附属中山医院心外科接受手术治疗的急性Stanford A型主动脉夹层患者,其中马凡综合征39例、先天二叶式主动脉瓣畸形28例,比较两组患者的临床表现、手术方式和术后30 d预后.结果 马凡综合征和先天二叶式主动脉瓣畸形发生急性夹层时均以胸背痛为主要症状(P>0.05),马凡综合征发病更早[(35±8)岁比(47±13)岁,P<0.01],主动脉窦部较先天二叶式主动脉瓣畸形扩张更明显[(55.4±9.8)mm比(42.6±8.6)mm,P<0.01],且主动脉瓣病变以反流较多见(69.2%比32.1%,P=0.003),先天二叶式主动脉瓣畸形则有25.0%表现为主动脉瓣狭窄.两组患者手术方式相似(P>0.05),但先天二叶式主动脉瓣畸形的术后30 d病死率明显高于马凡综合征(25.0%比5.1%,P=0.020).结论 马凡综合征和先天二叶式主动脉瓣畸形发生急性Stanford A型主动脉夹层有各自独特的临床特征,先天二叶式主动脉瓣畸形患者手术早期预后较差.
目的 探討馬凡綜閤徵與先天二葉式主動脈瓣畸形髮生急性Stanford A型主動脈夾層的臨床特徵和手術早期預後.方法 迴顧性分析2008年4月至2012年4月複旦大學附屬中山醫院心外科接受手術治療的急性Stanford A型主動脈夾層患者,其中馬凡綜閤徵39例、先天二葉式主動脈瓣畸形28例,比較兩組患者的臨床錶現、手術方式和術後30 d預後.結果 馬凡綜閤徵和先天二葉式主動脈瓣畸形髮生急性夾層時均以胸揹痛為主要癥狀(P>0.05),馬凡綜閤徵髮病更早[(35±8)歲比(47±13)歲,P<0.01],主動脈竇部較先天二葉式主動脈瓣畸形擴張更明顯[(55.4±9.8)mm比(42.6±8.6)mm,P<0.01],且主動脈瓣病變以反流較多見(69.2%比32.1%,P=0.003),先天二葉式主動脈瓣畸形則有25.0%錶現為主動脈瓣狹窄.兩組患者手術方式相似(P>0.05),但先天二葉式主動脈瓣畸形的術後30 d病死率明顯高于馬凡綜閤徵(25.0%比5.1%,P=0.020).結論 馬凡綜閤徵和先天二葉式主動脈瓣畸形髮生急性Stanford A型主動脈夾層有各自獨特的臨床特徵,先天二葉式主動脈瓣畸形患者手術早期預後較差.
목적 탐토마범종합정여선천이협식주동맥판기형발생급성Stanford A형주동맥협층적림상특정화수술조기예후.방법 회고성분석2008년4월지2012년4월복단대학부속중산의원심외과접수수술치료적급성Stanford A형주동맥협층환자,기중마범종합정39례、선천이협식주동맥판기형28례,비교량조환자적림상표현、수술방식화술후30 d예후.결과 마범종합정화선천이협식주동맥판기형발생급성협층시균이흉배통위주요증상(P>0.05),마범종합정발병경조[(35±8)세비(47±13)세,P<0.01],주동맥두부교선천이협식주동맥판기형확장경명현[(55.4±9.8)mm비(42.6±8.6)mm,P<0.01],차주동맥판병변이반류교다견(69.2%비32.1%,P=0.003),선천이협식주동맥판기형칙유25.0%표현위주동맥판협착.량조환자수술방식상사(P>0.05),단선천이협식주동맥판기형적술후30 d병사솔명현고우마범종합정(25.0%비5.1%,P=0.020).결론 마범종합정화선천이협식주동맥판기형발생급성Stanford A형주동맥협층유각자독특적림상특정,선천이협식주동맥판기형환자수술조기예후교차.
Objective To compare the clinical features of type A aortic dissection (AAD) in patients with Marfan syndrome (MFS) and bicuspid aortic valves (BAV).Methods Data from patients undergoing surgery for acute AAD between April 2008 and April 2012 at our institute were retrospectively collected.Patients were categorized into MFS group (n =39) and BAV group (n =28) to investigate their clinical and prognostic features.Results Patients in MFS and BAV groups always experienced the sudden onset of chest pain.MFS patients tended to have younger age [(35 ± 8) y vs (47 ± 13) y,P < 0.001],wider aortic sinus [(55.4 ± 9.8) mm vs (42.6 ± 8.6) mm,P < 0.01] and higher rate of moderate-to-severe aortic regurgitation (69.2% vs 32.1%,P =0.003).Patients in BAV group were featured with higher rate of moderate-to-severe aortic stenosis.Though the operation procedures were similar in both groups,the 30-day postoperative mortality was significantly higher among BAV patients (25.0% vs 5.1%,P =0.020).Conclusions MFS and BAV represent unique subgroups of acute type A aortic dissection.BAV-associated dissection demonstrated strikingly higher postoperative mortality in our study population.